Scabies & Lice Treatment Selector
Choose Your Treatment
Answer a few quick questions to find the most appropriate treatment for scabies or head lice based on your specific situation.
When it comes to getting rid of scabies or head lice, the first name most Australians hear is Elimite. But the market is crowded with creams, lotions, and oral pills that promise the same result. This guide breaks down how Elimite (permethrin) stacks up against the most common alternatives, so you can pick the right option for your situation without guessing.
What is Elimite and how does permethrin work?
Elimite is a topical cream that contains 5% permethrin, a synthetic pyrethroid insecticide. It is approved by the Australian Therapeutic Goods Administration (TGA) for both scabies and pediculosis capitis (head lice).
Permethrin works by disrupting the sodium channels in the nerves of mites and lice, causing paralysis and death within minutes. Because it targets the nervous system, it acts quickly and leaves the skin relatively unharmed.
Typical use: apply a thin layer to the entire body (or scalp for lice), leave it on for 8-12 hours, then wash off. In most cases a single application clears the infestation, though a second dose after a week may be recommended for stubborn cases.
Why compare alternatives?
Not every patient can use Elimite. Age limits, pregnancy, skin sensitivity, or drug resistance can make other options a better fit. Below are the main contenders and what sets them apart.
Top alternatives to Elimite (permethrin)
- Crotamiton - a milder topical agent often sold as Scabicidal Cream. Works by slowing mite movement rather than killing them outright.
- Benzyl benzoate - an oil‑based lotion that suffocates mites. Strong odor, but effective against resistant scabies.
- Ivermectin - an oral antiparasitic taken as a single dose (or two doses a week apart). Preferred for crusted scabies and when topical treatment is impractical.
- Lindane - a historic neurotoxic pesticide, now limited to severe cases due to safety concerns.
- Malathion - a lotion for head lice that works by breaking down the exoskeleton. Often used when resistance to pyrethroids is known.
- Tea tree oil (5%-10%) - a natural option with limited clinical data but popular among those avoiding chemicals.
Side‑by‑side comparison
| Product | Active ingredient | Formulation | Typical efficacy | Age limit (years) | Pregnancy safety | Key side effects |
|---|---|---|---|---|---|---|
| Elimite | Permethrin 5% | Cream | ≈95 % (single dose) | 2 months (infants), 12 months (head lice) | Category B (generally safe) | Mild itching, burning |
| Crotamiton | Crotamiton 10% | Cream | ≈80 % (multiple applications) | 6 months | Category B | Skin irritation, occasional rash |
| Benzyl benzoate | Benzyl benzoate 25% | Lotion/Oil | ≈85 % (single dose) | 2 years | Not recommended in pregnancy | Strong odor, burning sensation |
| Ivermectin | Ivermectin 200 µg/kg | Oral tablet | ≈90 % (2 doses) | 15 years (off‑label for younger) | Category C - use only if benefits outweigh risks | Headache, nausea |
| Lindane | Lindane 1% | Shampoo/Cream | ≈80 % (single dose) | 2 years (restricted) | Contraindicated in pregnancy | Neurotoxicity, skin irritation |
| Malathion | Malathion 0.5% | Lotion | ≈75 % (single dose) | 12 months (head lice) | Category C - avoid in pregnancy | Scalp itching, rare allergic reaction |
How to choose the right treatment
Here are the practical questions you should answer before picking a product:
- Who needs it? Infants under 2 months are usually steered toward crotamiton or benzyl benzoate because permethrin's safety data are limited for that age group.
- Are you pregnant or breastfeeding? Elimite is generally considered safe, but lindane and malathion are best avoided.
- Is resistance a concern? In some regions of Western Australia, permethrin resistance in head lice has risen to about 15 %. If you’ve tried a pyrethroid before and it failed, consider malathion or oral ivermectin.
- Do you have sensitive skin? Benzyl benzoate’s strong odor can aggravate eczema. Crotamiton is the gentlest on irritated skin, though it may need a second application.
- Cost and availability? Elimite is listed on the TGA schedule and covered by many private health funds. Over‑the‑counter benzyl benzoate is cheaper but may not be stocked in all pharmacies.
Answering these points usually narrows the field to one or two candidates, making the final decision simple.
Real‑world scenarios
Scenario 1 - A 3‑month‑old with scabies: The pediatrician recommends crotamiton cream applied nightly for three nights. Permethrin isn’t approved for infants under two months, and benzyl benzoate’s odor can upset the baby.
Scenario 2 - A teenager with stubborn head lice: After two failed permethrin washes, the doctor prescribes oral ivermectin (200 µg/kg). The single pill clears the infestation, avoiding the need for multiple messy lotion applications.
Scenario 3 - An adult with widespread crusted scabies: Because topical agents can’t penetrate thick crusts effectively, a combination of oral ivermectin (multiple doses) and daily permethrin cream is used. This dual approach hits the mites from both sides.
Safety tips and common pitfalls
- Always follow the exact application time. Leaving the cream on too long can increase skin irritation.
- Wash bedding, clothing, and towels in hot water (≥60 °C) after treatment to prevent re‑infestation.
- Resist the urge to “double‑dose” if itching persists; it’s often a post‑treatment reaction, not a treatment failure.
- Check the expiry date. Permethrin loses potency after two years, which can masquerade as resistance.
- For head lice, avoid using hair conditioners before applying the lotion - they create a barrier that reduces efficacy.
When to see a doctor
If you notice any of the following, schedule a consultation:
- Severe rash, blisters, or swelling after application.
- Persistent itching beyond two weeks despite a second dose.
- Signs of secondary bacterial infection (pus, crusted sores).
- Pregnancy or breastfeeding and you’re unsure which product is safe.
Medical professionals can prescribe oral ivermectin, order skin scrapings for lab confirmation, or suggest a different topical regimen.
Quick reference checklist
- Elimite (permethrin) - first‑line for most ages, high efficacy, safe in pregnancy.
- Crotamiton - best for infants and very sensitive skin.
- Benzyl benzoate - useful for permethrin‑resistant scabies, watch the smell.
- Ivermectin - oral option for crusted scabies, refractory lice, or when topical use isn’t possible.
- Lindane - limited to severe, refractory cases; avoid in pregnancy.
- Malathion - go‑to for pyrethroid‑resistant head lice.
How does Elimite actually kill scabies mites?
Permethrin blocks the sodium channels in the mites’ nerve cells. This causes a rapid loss of motor control, paralysis, and death within minutes after skin contact.
Can I use Elimite on a newborn?
Elimite is approved for children older than 2 months. For newborns, doctors usually recommend crotamiton or a supervised benzyl benzoate regimen.
What should I do if permethrin doesn’t work the first time?
Apply a second dose after 7 days. If itching continues beyond two weeks, contact a health professional - they may suggest an oral ivermectin course or a different topical.
Is malathion safe for children?
Malathion is approved for children as young as 12 months for head lice, but it should be avoided during pregnancy and used only under medical advice for scabies.
Do I need to treat my whole family if I have scabies?
Yes. Scabies spreads through prolonged skin‑to‑skin contact, so every close contact should receive treatment at the same time, even if they show no symptoms yet.
Casey Morris
October 24, 2025 AT 18:07Ah, the modern scourge of scabies and lice, a topic that, while seemingly mundane, actually demands a nuanced appreciation; I must say, the author has compiled a rather comprehensive overview, one that balances clinical rigour with layperson accessibility, indeed a commendable effort, though I suspect a few subtleties might have been glossed over, such as the pharmacokinetic intricacies of permethrin absorption, which, in my humble opinion, deserve further exposition.
Kester Strahan
October 27, 2025 AT 01:40Totally agree, the pharmacokinetic jargon is key – think of permethrin as a neurotoxic pyrethroid that blocks Na+ channels, kinda like a micro‑electric fence for mites; the dosage regimen is pretty straightforward, but the real‑world adherence can be, ya know, kinda tricky when people miss the 8‑12 hour wait time.
Doreen Collins
October 29, 2025 AT 12:00Reading through the side‑by‑side table was like watching a well‑orchestrated symphony of data, each row singing its own melody of efficacy, age limits, and safety profiles; I especially appreciated the clear delineation between topical and oral options, because for many families the decision hinges on not just the numbers but also on the practicalities of application, such as whether a toddler will tolerate an oil‑based lotion without a tantrum, and whether a busy parent can manage a repeat dose after a week; the author’s inclusion of pregnancy categories is a lifesaver for expectant mothers who are often left navigating a minefield of conflicting advice; moreover, the reminder to launder bedding at 60 °C is a simple yet often overlooked step that can make the difference between a one‑time cure and a relentless cycle of reinfestation; finally, the real‑world scenarios paint vivid pictures that help clinicians and patients alike visualize the treatment pathway, turning abstract guidelines into actionable steps.